Provider Demographics
NPI:1407013956
Name:WECARE COMPREHENSIVE FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:WECARE COMPREHENSIVE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:EHSANI-SHISHVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-707-0847
Mailing Address - Street 1:10632 LITTLE PATUXENT PKWY
Mailing Address - Street 2:STE #130
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3273
Mailing Address - Country:US
Mailing Address - Phone:410-707-0847
Mailing Address - Fax:410-715-9884
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY
Practice Address - Street 2:STE #130
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3273
Practice Address - Country:US
Practice Address - Phone:410-707-0847
Practice Address - Fax:410-715-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065701207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0065701OtherMEDICAL LICENSE